Objective To investigate the clinical efficacy of mitral valve repair technique in the treatment of rheumatic mitral valve lesions. Methods The clinical data of patients diagnosed with rheumatic mitral valve lesions and undergoing mitral valve repair under extracorporeal circulation in our department from 2021 to 2022 were retrospectively analyzed. Results A total of 100 patients were collected, including 78 females and 22 males with an average age of 52 years. There were no secondary open heart or death in the whole group. Extracorporeal circulation time was 136.3±33.1 min, aortic cross-clamping time was 107.6±27.5 min, ventilator use time was 12.9±5.9 h, ICU stay was 2.6±1.4 d, and vasoactive medication use was 823.4±584.4 mg. Before and after the surgery, there were statistical differences in the left ventricular end diastolic diameter, left atrial end systolic diameter, effective mitral valve orifice area, shortening rate of left ventricular short axis, mitral E-peak blood flow velocity, mean mitral transvalvular pressure difference, mitral pressure half-time, and cardiac function graded by New York Heart Association (P＜0.05). While there was no statistical difference in left ventricular ejection fraction or left ventricular end-diastolic volume (P>0.05). Conclusion Overall repair of rheumatic mitral valve lesions can significantly improve the cardiac function and hemodynamics of the patients, and is a good choice for patients with rheumatic mitral valve lesions.
Objective To assess the feasibility, safety, and validity of the TC-Dynamic posterior stabilized prosthesis implanted in the total knee arthroplasty (TKA). Methods Twelve knees of 10 patients (the TC-Dynamic group) were followed up, who had been implanted with the TC-Dynamic posterior stabilized prosthesis from September 2003 to March 2004. Preoperative KSS knee scores were 16.08±11.58, function scores 13.75±19.79, and the range of motion (ROM) of the knee 75.00±26.46°. Meanwhile, 50 knees of 30 patients (the Scorpio group) werefollowed up, who had undergone TKA with the Scorpio posterior stabilized prosthesis.Preoperative KSS knee scores were 19.48±967, function scores 3.16±19.82,andthe ROM of the knee 80.80±22.82°. The anteroposterior and lateral X-ray filmsof each knee were examined before and after operation. The statistical Z-test was used to analyze the differences between the 2 groups in the improvement of the KSS knee scores, function scores, and ROM after operation. Results The average of the 130 days’ follow-up revealed that the patients implanted with the TC-Dynamic prosthesis had an excellent result. In the TC-Dynamic group, the KSS knee scores were 88.83±4.04 with improved scores of 72.75±14.47 compared with those before operation; function scores were 79.17±5.15 with improved scores of 65.42±19.47; the ROM of the knee was 107.92±11.57° with increased degrees of 32.92±32.22°.Meanwhile, in the Scorpio group, the KSS knee scores were 85.68±7.36 with improved scores of 66.20±10.44 compared with those before operation; function scores were 71.40±12.70 with improved scores of 68.24±25.35; the ROM of the knee was 109.20±11.13° withincreaseddegrees of 28.40±26.41°.There was no significant difference in the improvement of the KSS knee scores, function scores, and ROM after operation between the 2 groups （Pgt;0.01）. All the X-ray films of the knees implanted with both the Scorpio prosthesis and the TC-Dynamic prosthesis were analyzed.No malalignment or lucent line with the prosthesis was seen in all these X-ray films. Conclusion The short-term follow-up indicates that the patients implanted with the TC-Dynamic prosthesis have an excellent result. The TC-Dynamic prosthesis with a scientific and proper design is more suitable for the Chinese. However, the long-term outcome of the patients implanted with the TC-Dynamic prosthesis should be observed in a larger number of TKA operations. The basic surgical principles, including excision of both the cruciate ligaments and correction of thebone deformity with the proper balancing of the soft tissues in flexion and extension, are still crucial to successful TKA and to the longterm high survivalrate of the knee prosthesis.
ObjectiveTo summarize clinical application progress of stereotactic radiotherapy for primary hepatocellular carcinoma. MethodsThe literatures about the research progress of the stereotactic radiotherapy for primary hepatocellular carcinoma were reviewed. ResultsRadiotherapy for hepatocellular carcinoma is importantly based on the radiation biology of the liver and the radiophysics of the liver cancer. Stereotactic precision radiotherapy is an effective and low toxic treatment for early hepatocellular carcinoma, moreover, it alone or in combination with microwave ablation, hepatic artery chemoembolization for unresectable hepatocellular carcinoma is safe and effective method for the treatment. ConclusionsThe optimal dose model for hepatocellular carcinoma, hepatocellular carcinoma radical dose level are problems that need further exploration, and radiobiology, radiation physics research must be strengthened to explore it, stereotactic precision radiotherapy treatment modalities in the treatment of hepatocellular carcinoma position will become increasingly people attention.
Objectives To investigate the clinical efficacy of health education intervention on chronic gastritis nursing. Methods A total of 142 patients with chronic gastritis in our hospital were recruited from February 2016 to June 2017. All patients were randomly assigned into two groups. The control group received conventional therapy and routine nursing, whereas the case group was offered with extra health education based on control group. Then related disease knowledge, nursing efficiency, nursing satisfaction, and nursing quality were compared. Results A total of 71 patients were in the case group, while 71 patients in the control group. Compared with the control group, the case group achieved better related disease knowledge, nursing satisfaction, total nursing efficiency, psychological status, sleep quality, exercise training, and daily diet (all P value<0.05). Conclusions Health education intervention not only can enhance disease knowledge of patients with chronic gastritis but also improve nursing quality, clinical effects and nursing satisfaction. Thus, it is worthy of further popularization in clinics.
ObjectiveTo evaluate the effectiveness of locking compress plate (LCP) for the treatment of aseptic diaphyseal humeral nonunions. MethodsBetween January 2006 and January 2012, 23 patients with aseptic diaphyseal humeral nonuninons were treated with LCP and autologous iliac crest bone graft, and the clinical data were retrospectively analyzed. There were 15 males and 8 females with the average age of 42.5 years (range, 28-60 years). The fracture located at left side in 11 cases and right side in 12 cases. The mechanism of the injury was traffic accident in 15 patients, and falling from height in 8 patients. Fracture was treated by internal fixation in 20 cases and external fixation in 3 cases. And 6 patients had open fractures and other 17 had close fractures. Based on the Weber-Cech classification, 6 cases were rated as atrophic nonunions, and 17 cases as hypertrophic nonuninons. Shoulder function was evaluated by Constant-Murley score and elbow function was evaluated by Mayo score. ResultsAfter operation, 2 patients had transient radial nerve symptoms of numbness and 1 patient had superficial infection. Primary healing of incision was obtained in the other patients. All patients were followed up 22.22 months on average (range, 16-30 months). Normal range of motion of the shoulder was found in 11 cases; and limited movements of abduction, elevation, and posterior extension were observed in 12 cases. And osseous union was observed clinically and radiographically in all patients. The average union time was 16.95 weeks (range, 12-24 weeks). The average Constant-Murley score was 81.87 (range, 50-98); and shoulder function was excellent in 14 cases, good in 6, and fair in 3. And the average Mayo score was 87.78 (range, 70-96); and the result was excellent in 14 cases, good in 7, and fair in 2. ConclusionAseptic diaphyseal humeral nonunions can be successfully treated with LCP, coupled with the use of autologous iliac crest bone graft.
Objective To retrospectively analyze the cl inical effect of l ightbulb operation with nano-hydroxyapatite/ collagen in a consecutive series of patients with osteonecrosis of the femoral head (ONFH). Methods From January 2001to July 2005, 26 patients (35 hips) were treated, 16 males and 10 females, aged 19-54 years old (33.5 on average). The course of disease was 12-36 months (18 months on average). Based on the etiology, 15 cases (22 hips) were steroid induced type, 10 (12 hips) were alcohol induced type and the other one (1 hip ) was idiopathic type. According to the system of Association Research Circulation Osseous (ARCO), there were 6 hi ps of stage IIB, 16 hi ps of stage IIC, 9 hi ps of stage IIIA, 3 hi ps of stage IIIB and 1 hip of stage IIIC. The Harris score was 62.2 ± 7.5. All the patients who had undergone l ightbulb operation with nano-hydroxyapatite/collagen were evaluated both cl inically and radiographically. The bone graft mixture rate of nanohydroxyapatite/ collagen and autogenous bone was 1 ∶ 1, and the mixed bone graft was 6 times of the scraped osteonecrosis volume (30-48 mL). Results The incisions of all 26 patients (35 hi ps) obtained heal ing by first intention. The 2 cases, which got lateral femoral cutaneous nerve injury during the operation, recovered 3-6 months after the operation without any treatment. Another 2 cases got heterotopic ossification 3 months after operation, with no special treatment. All the 26 patients (35 hips) were followed up for 2-7 years (3.5 on average). The patients’ bone heal ing began from the 3rd month after operation. The postoperative Harris score was 85.1 ± 16.2, and there was significant difference compared with the preoperative one (P lt; 0.001). There were 15 hips of excellent, 11 of good, 5 of fair, and 4 of poor which received total hip arthroplasty at the end of the follow-up. According to imaging, 5 hips were progressed from preoperative IIC to IIIA, while the other hips were radiologically stable, with no progress of ONFH. Conclusion Lightbulb operation with nano-hydroxyapatite/collagen provides a surgical treatment to treat early ONFH with satisfactory cl inical outcomes. Nano-hydroxyapatite/collagen is beneficial for the repair and reconstruction of ONFH and suitable for femoral-head-preserving operation for the patients with ONFH of stage II.
【摘要】 目的 探讨莫西沙星对急性肺脓肿治疗的临床疗效及安全性分析。方法 选择2008年6月—2009年6月收治的36例急性肺脓肿患者,随机分为莫西沙星组和对照组,分别给予静脉滴注莫西沙星和头孢哌酮舒巴坦联合替硝唑治疗。比较两组疗效及安全性。结果 莫西沙星组和对照组总有效率分别为90.63%、93.75%;细菌敏感性分别为73.3%、86.7%;细菌清除率分别为83.7%、92.4%;不良反应总发率分别为16.7%、11.1%。两组比较无统计学差异(Pgt;005)。结论 经验性莫西沙星治疗急性肺脓肿的疗效及安全性与头孢哌酮舒巴坦联合替硝唑相似。但莫西沙星治疗费用低且利于口服序贯治疗而更具有优势,可推荐作为经验性或首选用药。
ObjectiveTo compare clinical efficacy of totally laparoscopic gastrectomy (TLG) and conventional laparoscopy-assisted gastrectomy (LAG) and to explore safety and feasibility of total laparoscopic anastomosis in laparoscopic gastrectomy. MethodThe clinical data of 64 patients who received TLG and another 70 patients who received conventional LAG in our department from January 2013 to March 2014 were retrospectively analyzed. ResultsAll procedures were completed successfully. There were no significant differences in the time of anastomosis〔(73.8±10.3) min versus (72.7±8.9) min, t=0.693, P=0.489〕 and the number of dissected lymph nodes (32.4±9.7 versus 33.6±9.6, t=-0.700, P=0.485) between the patients underwent TLG and the patients underwent LAG. However there were obvious differences in the blood loss〔(275.0±66.3) mL versus (364.3±75.7) mL, t=-7.419, P=0.000〕, the incision length〔(3.0±0.8) cm versus (7.3±1.7) cm, t=-19.354, P=0.000〕, the time to fluid diet〔(4.9±0.8) d versus (6.0±0.7) d, t=-8.750, P=0.000〕 and the time to flatus 〔(2.8±0.8) d versus (3.9±0.8) d, t=-8.388, P=0.000〕, the off-bed time〔(1.3±0.5) d versus (3.4±1.2) d, t=-14.118, P=0.000〕, and the hospital stay〔(9.8±1.2) d versus (13.0±1.5) d, t=-17.471, P=0.000〕 between the patients underwent TLG and the patients underwent LAG. Meanwhile it was found that the postoperative pain score〔On day 1 postoperatively: (3.4±0.8) points versus (6.2±1.3) points, t=-15.509, P=0.000; on day 3 postoperatively: (1.7±0.6) points versus (4.0±0.8) points, t=-18.799, P=0.000〕 and the dosage of pain killers (1.7±0.7 versus 4.0±2.1, t=-8.912, P=0.000) in the patients underwent TLG were significantly lower than those in the patients underwent LAG. One patient developed anastomotic leakage and 3 patients developed anastomotic stenosis in the patients underwent LAG, the complication rate related to the anastomosis was 5.7% (4/70). While there were no complications related to the anastomosis in including anastomotic leakage, stenosis, and bleeding in the patients underwent TLG. ConclusionsTotal laparoscopic anastomosis is safe and feasible in laparoscopic gastrectomy for gastric cancer. Compared with small incision-assisted anastomosis, totally laparoscopic anastomosis is associated with minimal trauma, less blood, quicker postoperative recovery, shorter time, slighter pain and satisfactory short-term efficacy.
ObjectiveTo investigate the clinical effect and the incidence of postoperative complications of Milligan-Morgan hemorrhoids combined with reducing tension of alary incision in the treatment of annular mixed hemorrhoids.MethodsProspectively collected 120 patients with annular mixed hemorrhoids who received treatment from the Department of Colorectal Surgery of Bazhong Hospital of Traditional Chinese Medicinel during the April, 2016 to October, 2018. All of the 120 patients with annular mixed hemorrhoids were randomly divided into the experimental group and the control group, with 60 patients in each one group. Patients in the experimental group was treated with Milligan-Morgan hemorrhoids combined with reducing tension of alary incision, while patients in the control group with conventional Milligan-Morgan hemorrhoid.ResultsIn the experimental group, 49 cases were cured, 11 cases showed obvious effect; in the control group, 39 cases were cured, 20 cases showed obvious effect, and 1 case was effective. The curative effect in experimental groups was better than that of the control group (Z=–2.090, P=0.037), and the effective rates of these two group were both 100% in total. The mean healing time was (19±3) d (14–21 d) in the experimental group and (21±3) d (14–24 d) in the control group, respectively, which was better in the experimental group (Z=–13.636, P<0.001). Experimental group with lower score of wound pain, hemafecia, and anal margin edema, which were much better than control group on 1 d and 3 d after operation (P<0.05). There was no statistically significant differences on incidence of uroschesis and recurrence rate between the two groups (P>0.05).ConclusionsMilligan-Morgan hemorrhoids combined with reducing tension of alary incision in the treatment of annular mixed hemorrhoids has good clinical effect and deserves clinical application.
Objective To analyze the outcomes and complications after total knee replacement(TKR) with posterior stabilized prosthesis(PS) and to investigate the influencing factors relating to outcomes. Methods From January 1998 to August2004, 60 cases (74 knees) of osteoarthritis underwent TKR with PS. The outcomeswere evaluated according to the HSS(hospital for special surgery) scoring. The difference in outcomes between patients with post-operative complications and without complications were compared. Pearson correlation was used to analyze post-operative outcomes and the pre-operative factors relating to patients. Results All 74 knees werefollowed up 42.5months(24 to 94 months). The scores for HSS, pain, function, ROM muscle strength, flexion deformity and stability of knees after operation were 84.2±14.2, 25.7±6.9, 17.9±4.3,13.1±2.0，9.2±0.8，8.1±0.4 and 9.3±0.1 respectively. They were improved to some extents, especially pain alleviation was remarkable. The excellent and good rate for outcome assessment was 90.5%. Among 74 knees, 10 cases suffered from postoperative complications, including 1 case of common peroneal nerve paralysis, two cases of wound faulty union, one case of wound infection, one case of joint infection, one case of stiff knee, two cases of deep vein thrombosis and 2 cases of patellofemoral joint complications. The excellent and good rate of outcome in patients with complications(60%) was much lower than that in patients without complication(95.3％),and there was significant difference betweenthem (P＜0.05). Analysis for correlation showed that postoperative HSS score was positively correlative with the postoperative HSS score, pain and function score of knees. The correlation value was 0.523，0.431 and 0.418 respectively(Plt;0.01). Whereas, postoperative HSS score was not correlative with ROM, muscle strength, flexion deformity, stability of knee, age, weight andbody mass index(P＞0.05). Conclusion TKR with PS is an effective method for severe osteoarthritis. The outcomes after TKR have a positive correlation with the HSS score, pain and function score of knees before surgery. Complicationsassociating with surgery have a negative influence on outcomes.